Research Proposal: Factors & Coping with Stress Among ER Nurses, KSA

This research proposal investigates the sources of stress among emergency room nurses in Saudi Arabia and their coping strategies. It addresses the high percentage of foreign nurses in the Saudi healthcare sector and the prevalence of burnout syndrome. The study aims to determine the factors causing stress in emergency wards, assess the impact of stress on nurses' work conditions, and identify effective coping strategies. The research questions focus on the significant stressors in Saudi Arabian emergency wards, the extent to which professional stress affects nurses considering socio-demographic and job variables, and the strategies to cope with work-related stress. The study's significance lies in its contribution to understanding nurse work-stress and burnout in the Saudi Arabian context, comparing expatriate and Saudi Arabian nurses, and identifying prevalent stress types in emergency wards. The limitations include a lack of sample variation in nationalities and the absence of semi-structured personal interviews. The literature review covers the definition of stress, its symptoms, sources, and outcomes, as well as the influence of socio-demographic variables.

Running head: RESEARCH PROPOSAL
FACTORS AND COPING STRATEGY OF STRESS AMONG THE EMERGENCY
ROOM NURSES IN SAUDI ARABIA.
Name of the Student:
Name of the University:
Author Note:

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Table of Contents
CHAPTER 1: INTRODUCTION..............................................................................................9
1.2 Problem Statement.........................................................................................................10
1.3 Objective of the Study....................................................................................................10
1.4 Research Questions........................................................................................................11
1.5 Significance of the Study...............................................................................................11
1.6 Limitations of the Study.................................................................................................12
1.7 Operational Definitions..................................................................................................12
CHAPTER 2: REVIEW OF LITERATURE...........................................................................13
CHAPTER 3: METHODOLOGY...........................................................................................16
3.2 Setting of the Study........................................................................................................16
3.3 Population......................................................................................................................17
3.5 Sampling Criteria...........................................................................................................17
3.6 Sample and Its Size........................................................................................................17
3.7 Variables........................................................................................................................18
3.8 Instrument......................................................................................................................18
3.9 Validity and Reliability..................................................................................................19
3.10 Pilot Study....................................................................................................................20
3.11 Data Collection Procedure...........................................................................................20
3.12 Data Analysis...............................................................................................................21
3.13 Ethical Considerations.................................................................................................21

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CHAPTER 4: EXPECTED RESULTS....................................................................................21
CHAPTER 5: DISCUSSION AND CONCLUSION..............................................................22
References................................................................................................................................24
Appendices Appendix 1: Gantt Chart.....................................................................................27

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CHAPTER 1: INTRODUCTION
1.1 Background of the Study
Stress is often identified in terms of the mental, physical and the emotional responses
that shows that an individual is stressed. It can also be referred to be as the sum of the metal
physical and emotional strains that results from the interaction with the people or with their
environment in which they live in (Attar 2014). Lots of studies have been carried out for the
examination of the stress of the nurses especially in the hospital or health care setting.
Working in an emergency duty environment, there are often incidences of threats and several
other causes of experiences which lead to the development of stress at work for the nurses
engaged in duty in the emergency department of the hospitals (Eswi, Radi and Youssri 2013).
This includes the job roles like provision of care to the dying, ambiguity of the roles, along
with the conflicts arising with the other health personnel in addition to career planning. As a
result this work stress often escalates as the most severe occupational health hazards that one
faces while working that leads to the reduction of satisfaction among the workers along with
the decrease of their productivity (Al-Makhaita, Sabra and Hafez 2014). This often leads to
the effect on the turnover of the employees. The continuous work stress at work ends up in
emotional problems which the nurses the face on a daily basis along with worker burnout due
to over stress that might also effect physically (Hamaideh, Al-Omari and Al-Modallal 2017).
The nursing staff who are involved in the emergency wards are most of time subjected to
elevated stress levels since most of the time they are challenged by the fast changing
environment around them. Studies conducted in respect to this have shown that medical
errors are directly proportional to the work stress faced and most of the time these are
preventable errors (Keriri 2013).

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1.2 Problem Statement
It has been seen that about more that 70% of the nursing workforce working in the health care
sector in Saudi America belong to some foreign country and this factor elevates the stress in
respect to their professional work (Lamadah and Sayed 2014). Previously conducted research
has shown that there is an existence of burnout syndrome in the nurses working the
emergency department in the hospitals of Saudi Arabia (Mosadeghrad 2013). The studies
have also reported that the prevalence of the burnout syndrome is mostly seen in Saudi
Arabia in comparison to the other countries since most here the evolution to the nursing
profession has been neglected (Al Hosis, Mersal and Keshk 2013). Very little had been done
in terms of improvement of the working situations and also for the improvement of the self–
esteem of the nurses. This as a result has affected the nursing staff thus intriguing the rise of
stress and their critical nature of their work. This also ended up in shortage of staff during
emergency situations where very few nurses were available for the care of patients (Al-
Makhaita, Sabra and Hafez 2014). All this resulted in the negative health conditions which
impacted the personal well-being of the individual nurses and therefore reducing the efficacy
and the quality of the care of the patients.
1.3 Objective of the Study
The study aims to investigate the following aspects:
 Determination of the sources of stress in the emergency wards of the hospitals of
Saudi Arabia
 The level to which the stress has an impact on the work condition of the nurses

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 The strategies to cope up with the prevalent stress conditions
1.4 Research Questions
The research questions developed for this study are as follows:
 What are the significant factors or rather the sources of stress that is prevalent in the
emergency wards of the hospitals present in Saudi Arabia?
 To what level or what extend does the extent of professional stress is affected by the
nurses? Is it the socio-demographic variable and job variables or any other factor?
 What strategies should be undertaken in order to cope up with the work stress that the
nurses are facing on a daily basis? Additionally what is the relationship between the
stress and the outcomes that is anticipated?
1.5 Significance of the Study
This study is quite significant in terms that much research is not carried out in the
context of nurse work-stress and burnout in the Saudi Arabian setting therefore this study
helps to show the factors that are responsible for the prevalent conditions of stress (AbuRuz
2014). The staffs who are suffering from this heightened condition of stress might end up in
suffering from burnout syndrome; therefore this study helps to explore the outcomes that are
related to work stress (Aboshaiqah 2016). This study is also significant in terms that it
compares the expatriate nurses and ethnic Saudi Arabian nurses. Since the amount of stress
depends on the area the nurses are working in therefore this study helps to identify the kind of
stress that is prevalent in the emergency wards (Al Sareai et al. 2013).
1.6 Limitations of the Study

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Although the study is quite significant, however there were certain limitations in the
study like when the sample or the participants of the study was considered, there were
participants only from few nationalities therefore there was not ample variation present in the
sample (Gillespie, Gates and Berry 2013). This had an impact on the study especially in
terms of determination of the sources of stress and the anticipated outcomes of the stress.
Another drawback was that there was a requirement of a semi-structured personal
interviewed which would have produced different results in comparison to the one used in the
present study (Almajwal 2016).
1.7 Operational Definitions
BS – Burnout syndrome
ED- Emergency department
ERC- Ethics and Research committee
SPSS- Statistical Package for the Social Sciences
ANOVA- Analysis of variance
CHAPTER 2: REVIEW OF LITERATURE
2.1 Search Strategy

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In order to conduct a proper search, it was required to examine relevant articles
critically also with certain books which are relevant to the research tile. The search engines
like Google Scholar, PMC, and PubMed will be used to conduct systematic research. Just the
articles published within the most recent eight years will be incorporated into the audit. 40
studies will be recovered from the database after a quality check. 20 studies will be
incorporated into the basic audit. Ten of the investigations will be prohibited because of
duplication, and the other ten of them had confined access. The explicit key terms utilized in
the hunt are pain and pain appraisal in addition to nurture, basic consideration, nursing
learning, and fundamental support of life.
2.2 Overview on stress and the outcome of stress prevalent among the nurses working in
ED
The nature and definition of stress
The influence of strain on the physical and psychological wellness is outstanding and
additionally the profitability of both the association and the representative is a developing
worry of administrations. In reality, the pressure and burnout are in some cases considered
among the authoritative conduct real worries of the decade. Literature incorporates many
definitions of stress (Cañadas-De la Fuente et al. 2015). The vast majority of which include
the mind boggling connection between an individual and his/her workplace (Karkar,
Dammang and Bouhaha 2015). As per some pressure is characterized as a mental and
physiological distress that is experienced when workplace requests surpass an individual's
adapting methodologies. Hence, it can easily deduced that work-stretch is useful for the
employee to adapt successfully to the work necessities, yet expanded or consistent adapting
some of the time harms the specialist and may prompt undesirable outcomes particularly if

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the prerequisites persistently surpasses the specialist aptitudes and capacities (Al-Ahmadi
2014).
Symptoms of stress
There are several signs as well as symptoms which are able to reflect the existence of
stress. Some of the literature present are able to classify the symptoms of stress into
physiological, emotional and behavioural factors. There are physiological indications which
comprise of the surge in blood pressure, breathing rate, heart rate, and sweating (Al-Qahtani
2015). Although, in case the stress is continuous, there are certain unpleasant and hazardous
results including an increase in the level of cholesterol, heart attacks and ulcers which might
appear. The most frequently observed or reported emotional indications include anxiety,
depression, tension, absence of interest, desperateness, psychological exhaustion, and low
self-esteem or sureness. In care there is a surge in the stress level, it is associated with
reduced expectation of job satisfaction (Hamaideh 2014). Along with that, a few most
abundantly observed occupational behavioural symptoms include factors like absenteeism,
lack of concentration, decreased performance and communication along with higher alcohol,
more turnover rates, drug abuse, higher rate of smoking and unexpected behavior (Eswi, Radi
and Youssri 2013).
Sources of work-stress
Past investigation uncovered that there are numerous makes associated work-stretch.
As indicated by a few analysts, reasons for work-stress might be discovered both inside
worker identity and inside the workplace. Likewise, absence of clear heading with respect to
the association objectives was observed to be among the noteworthy reasons for work
pressure. Job vagueness, job strife, and lucidity of hierarchical objectives were likewise
observed to be of huge association with work-worry among 433 of the representatives of

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seven Kuwaiti legislative areas (Attar 2014). A similar report expressed that the activity
nature and its requests cause pressure. Another investigation led in Saudi Arabia
demonstrated that the impact of occupation requests on essential human services specialists'
public activity was a wellspring of stress. Numerous specialists have demonstrated that BS is
very basic among specialists and medical caretakers. It was found in an investigation that BS
was progressively basic among attendants in contrast with specialists. Hamaideh, Al-Omari
and Al-Modallal (2017) revealed that 14.4% of their examination assemble were tolerably
burnout. The pervasiveness of BS among medical caretakers contrasts from unit to unit of
their work. Keriri (2013) revealed that medical attendants in neonatal emergency unit
encounter abnormal amounts of psychologic and physical pressure which prompts burnout,
though found that BS in the crisis ward is normal and is affected by the situation of the staff
and the sex (Al Hosis, Mersal and Keshk 2013).
Outcomes of Work-stress
Past research likewise uncovered expensive adverse results of work pressure. A great deal of
conduct issues caused by business related worry; among these issues unfortunate connections
among colleagues, increment rate of non-attendance, and steady loss of fearlessness
(Aboshaiqah 2016). Another examination led on medical caretakers in Saudi Arabia
uncovered that upsetting attendants were bound to leave their healing facilities than those
with less work-push were. Stress can likewise prompt wellbeing and social issues, for
example, heart and chest issues, utilization of liquor and medications (Almajwal 2016).
Hence, uncovering the reasons for professional burnout will help decreasing the unfortunate
impacts of work-stress.
Socio-demographic variables and Work-stress

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In an examination directed in the United States it was discovered that ED specialists
and medical attendants vary in mean feelings of anxiety. Numerous investigations found that
the dimension of work-stress change as indicated by contrasts in socio-economic factors. An
examination uncovered that the more established the representative, the less work-feeling of
anxiety, however the higher the instructive dimension, the more work-feeling of anxiety
(Gillespie, Gates and Berry 2013). Females were bound to report being focused. Another
examination led to research the wellsprings of occupation worry among Kuwaiti and non-
Kuwaiti government representatives uncovered that Kuwaiti workers were altogether
progressively worried on all elements of worry aside from on the professional improvement
where the non-Kuwaiti representatives experienced higher pressure (Cañadas-De la Fuente et
al. 2015).
CHAPTER 3: METHODOLOGY
3.1 Research Design
The study will implemented a qualitative study through the collection data using
questionnaires. A random sampling of the data will be carried out since it would help the
investigators to assess the data and the record analytically so that the factors can be identified
along with the outcomes of the stress that are faced by the nurses working in the emergency
department.
3.2 Setting of the Study
The study setting were the different hospitals which were based on the cities that
belonged to the Saudi Ministry of Health. The different hospitals which were selected had the
emergency wards, which were then sampled through random stratification, which will help to

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represent the target population that included the doctors, nursing staff, and the allied staff
along with the administrators who were engaged in working in the hospitals under the Saudi
Ministry of Health.
3.3 Population
The participants or the population of the study will be thetarget group which will
consist of thedoctors, nursing staff, and the allied staff along with the administrators who
were engaged in working in the hospitals under the Saudi Ministry of Health.
3.5 Sampling Criteria
The sampling criteria will be selected in such a way that it would help in the selection
the sample from the population so that information could be obtained in a phenomenon which
helps to represent the interest of the population. The sample will be rationalized by the
consultations with the Ministry of Health personnel. There were certain inclusion criteria like
the nurses who should be working as the local registered nurses.
3.6 Sample and Its Size
There will be about 100 registered nurses who will form the total sample population.
Among them there will be about 50 local nurses and 50 nurses who although will be
registered locally but belonged to foreign countries. There is a requirement of stratification of
the sample in accordance to the nursing cadre per clinic so that the respondents could be
selected from the given population. From the given sample about 50% of the population will
be subjected to the questionnaires. This will facilitate the establishment of the opportunity to